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Difference between revisions of "Barrett's esophagus"
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Barrett's esophagus (view source)
Revision as of 14:23, 15 September 2022
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| Other = | | Other = | ||
| ClinDDx = | | ClinDDx = | ||
| Tx = on-going surveillance for [[columnar dysplasia of the esophagus|columnar dysplasia]] | |||
}} | }} | ||
:''Intestinal metaplasia of the esophagus'' redirects here. | :''Intestinal metaplasia of the esophagus'' redirects here. | ||
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*Diagnosis is made by '''clinicans ''not'' pathologists'''. | *Diagnosis is made by '''clinicans ''not'' pathologists'''. | ||
**A common histologic correlate is metaplastic transformation of stratified squamous epithelium to simple columnar epithelium with goblet cells. | **A common histologic correlate is metaplastic transformation of stratified squamous epithelium to simple columnar epithelium with goblet cells. | ||
***There is disagreement whether goblet cells are required for the diagnosis.<ref name=pmid19623166>{{Cite journal | last1 = Riddell | first1 = RH. | last2 = Odze | first2 = RD. | title = Definition of Barrett's esophagus: time for a rethink--is intestinal metaplasia dead? | journal = Am J Gastroenterol | volume = 104 | issue = 10 | pages = 2588-94 | month = Oct | year = 2009 | doi = 10.1038/ajg.2009.390 | PMID = 19623166 }}</ref> | ***There is disagreement whether goblet cells are required for the diagnosis.<ref name=pmid19623166>{{Cite journal | last1 = Riddell | first1 = RH. | last2 = Odze | first2 = RD. | title = Definition of Barrett's esophagus: time for a rethink--is intestinal metaplasia dead? | journal = Am J Gastroenterol | volume = 104 | issue = 10 | pages = 2588-94 | month = Oct | year = 2009 | doi = 10.1038/ajg.2009.390 | PMID = 19623166 }}</ref> In the United States and Canada goblet cells are required for the diagnosis.<ref name=pmid29998421>{{cite journal |authors=Odze R |title=Histology of Barrett's Metaplasia: Do Goblet Cells Matter? |journal=Dig. Dis. Sci. |volume=63 |issue=8 |pages=2042–2051 |date=August 2018 |pmid=29998421 |doi=10.1007/s10620-018-5151-z |url=}}</ref> In the UK, goblet cells are not required. | ||
****One large study suggests that goblets cells are only absent due to undersampling.<ref name=pmid21959311>{{Cite journal | last1 = Chandrasoma | first1 = P. | last2 = Wijetunge | first2 = S. | last3 = DeMeester | first3 = S. | last4 = Ma | first4 = Y. | last5 = Hagen | first5 = J. | last6 = Zamis | first6 = L. | last7 = DeMeester | first7 = T. | title = Columnar-lined esophagus without intestinal metaplasia has no proven risk of adenocarcinoma. | journal = Am J Surg Pathol | volume = 36 | issue = 1 | pages = 1-7 | month = Jan | year = 2012 | doi = 10.1097/PAS.0b013e31822a5a2c | PMID = 21959311 }}</ref> | ****One large study suggests that goblets cells are only absent due to undersampling.<ref name=pmid21959311>{{Cite journal | last1 = Chandrasoma | first1 = P. | last2 = Wijetunge | first2 = S. | last3 = DeMeester | first3 = S. | last4 = Ma | first4 = Y. | last5 = Hagen | first5 = J. | last6 = Zamis | first6 = L. | last7 = DeMeester | first7 = T. | title = Columnar-lined esophagus without intestinal metaplasia has no proven risk of adenocarcinoma. | journal = Am J Surg Pathol | volume = 36 | issue = 1 | pages = 1-7 | month = Jan | year = 2012 | doi = 10.1097/PAS.0b013e31822a5a2c | PMID = 21959311 }}</ref> | ||
*Associated with [[gastroesophageal reflux disease]] (GERD). | *Associated with [[gastroesophageal reflux disease]] (GERD). | ||
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**Normal mucosa = light pink. | **Normal mucosa = light pink. | ||
===Prague Classification Barrett's Esophagus=== | |||
*Commonly used in by endoscopists. | |||
*Quantifies the extent of Barrett's esophagus. | |||
Meaning:<ref name=pmid22248595>{{cite journal |vauthors=Vahabzadeh B, Seetharam AB, Cook MB, Wani S, Rastogi A, Bansal A, Early DS, Sharma P |title=Validation of the Prague C & M criteria for the endoscopic grading of Barrett's esophagus by gastroenterology trainees: a multicenter study |journal=Gastrointest Endosc |volume=75 |issue=2 |pages=236–41 |date=February 2012 |pmid=22248595 |pmc=4547779 |doi=10.1016/j.gie.2011.09.017 |url=}}</ref> | |||
*C = circumferential length. | |||
*M = maximal length. | |||
===Images=== | |||
<gallery> | <gallery> | ||
Image:Barretts_esophagus.jpg | Endoscopic image of BE. (WC) | Image:Barretts_esophagus.jpg | Endoscopic image of BE. (WC) | ||
</gallery> | </gallery> | ||
==Microscopic== | ==Microscopic== | ||
Features: | Features: | ||
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==Sign-out== | ==Sign-out== | ||
<pre> | |||
Esophagus, Distal, Biopsy: | |||
- Columnar epithelium with intestinal metaplasia, see comment. | |||
- Reactive squamous epithelium. | |||
- NEGATIVE for dysplasia and NEGATIVE for malignancy. | |||
Comment: | |||
The findings are consistent with Barrett's esophagus in the appropriate endoscopic setting. | |||
</pre> | |||
===Block letters=== | |||
<pre> | <pre> | ||
ESOPHAGUS, DISTAL, BIOPSY: | ESOPHAGUS, DISTAL, BIOPSY: | ||